Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

The Director of Proceedings charged that a Doctor was guilty of professional misconduct in that he failed to appropriately manage and treat a patient, and he failed to keep adequate patient records. The particulars were as follows:

1. On or about 13 January 1997, 3 April 1997 and 27 April 1997 the Doctor unnecessarily administered Vitamin B 12 injections to his patient which were of no clinical benefit to his patient's diagnosed conditions.
   AND/OR
   
   
2. On and between 13 January 1997 and 27 April 1997 the Doctor administered Vitamin B12 injections to his patient without obtaining his informed consent.
   AND/OR
   
   
3. On or about 6 April 1997 and 27 April 1997 the Doctor administered Solu-Cortef to his patient for no clinically appropriate reason in his client's circumstances.
   AND/OR
   
   
4. On or about 6 April 1997 and 27 April 1997 the Doctor administered Solu-Cortef to his patient without a treatment plan.
   AND/OR
   
   
5. On or about 6 April 1997 and 27 April 1997 the Doctor administered Solu-Cortef to his patient without obtaining his informed consent.
   AND/OR
   
   
6. The Doctor failed to develop an appropriate plan to attempt to manage his patient's pain.
   AND/OR
   
   
7. The Doctor failed to investigate his patient's increasing and debilitating pain.
   AND/OR

9. The Doctor failed to keep adequate clinical records in that his records did not include a note of the presenting complaint, history of condition, the examination findings nor an adequate record of treatment.

      Particular 8 was withdrawn by the Director of Proceedings at the conclusion of the Director's case 
      against  the Doctor.

Background: 

In December 1996, the patient had been suffering from neck and back pain for several years and he had been diagnosed as suffering from osteoarthritis of the lower back and cervical spine. On 16 December the patient went to see a practitioner (Dr A) for the first time. The respondent doctor (the Doctor) was in practice with Dr A and it was customary for him to see Dr A's patients if Dr A was unavailable. It was in this context that the Doctor first saw the patient on 11 January 1997.

At the first consultation the Doctor performed a physical examination, took the patient's blood pressure, and also performed a neurological examination which disclosed no abnormalities. There was mild tenderness over the lumbar cervical spine which he attributed to osteoarthritis. He prescribed Voltaren for back pain - for which the patient was also taking Acupan and Naprosyn and Sandomigran for his headaches.

The Doctor saw the patient again for neck and back pain on 13 January 1997, and on this occasion the patient's partner asked if there were any other possible treatments for the patient's pain, beyond what was being prescribed. Given he was already taking anti-inflammatories and pain killers, the Doctor suggested trying a vitamin B12 injection. The Doctor told them vitamin B12 was commonly used in South Africa and was a successful form of pain relief in such circumstances. It tends to provide a sense of "well being".

The next day the Doctor saw the patient again. He did not complain of any neck or back pain and the Vitamin B12 appeared to have had a positive effect. The Doctor said that he always checked to see if medication is working well, and he would not have repeated the Vitamin B12 injections if the patient had given him a negative response.

On 6 April 1997, the patient was troubled by pain in his right knee and ankle. The Doctor suggested Solu-Cortef. The Doctor said he explained that he expected it would give rapid short term relief for pain caused by osteoarthritis and he explained that it would have some potential side-effects but that these were associated with long term use. The Doctor asked the patient to return for evaluation in the next few weeks.

The patient returned on 27 April 1997 with pain in his ankle, knee and cervical spine. The Doctor administered a second Solu-Cortef injection and Vitamin B12. The Doctor said he discussed these with the patient and he was happy with both treatments.

The Doctor said he understood that both Vitamin B12 and Solu-Cortef would give short-term relief only. The Doctor said his plan of action would have been to have referred the patient on to a specialist for further treatment if necessary. However, shortly after he had tried the medications, he ceased seeing the patient so the opportunity to follow-up with a referral did not present itself.

Finding:

The Tribunal found the Doctor not guilty of professional misconduct.

The Tribunal was satisfied particulars 1-6 were not established.

The Tribunal was satisfied the Doctor was aware that both medications were well-tolerated, safe, and 'would do no harm'. The Tribunal was also satisfied that there was sufficient evidence to establish to its satisfaction the Doctor probably did tell the patient that the injections "might help" and that, in the circumstances and on the basis of his evidence (which the Tribunal accepts), he did provide sufficient information to enable the patient to give his informed consent. In any event, the Tribunal was not satisfied that the Director of Proceedings was able to establish, to the requisite standard of proof, that there was any failure or omission in this regard by the Doctor.

When considering particular 7 the Tribunal was satisfied there was simply no evidence of a clinical 'picture' of increasing pain presented to the Doctor. The Tribunal found that the evidence suggested the patient's pain increased from approximately mid-August 1997 well after the last time the Doctor saw him in May 1997.

The Tribunal found particular 9 was not established. It was satisfied that the records kept by the Doctor in relation to his consultations with the patient were adequate.